[{"id":"da-idea-inclusive-anti-amyloid-trials","kind":"idea","name":"Antibody trials that enrol mixed and comorbid disease","aka":[],"tldr":"Test amyloid antibodies in the mixed, comorbid people clinics actually see, instead of only in tidy trial cohorts.","summary":"Until that trial exists, labels and MRI rules should stay conservative. This idea is a proposed test, not a reason to ignore exclusions.","asOf":"2026-09-21","links":[{"label":"ClinicalTrials.gov","url":"https://clinicaltrials.gov"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease","mixed-dementia"],"sections":[],"technologies":[],"targets":[],"drugs":["da-lecanemab","da-donanemab"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-trial-exclusion"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A pragmatic trial in people with mixed pathology or common comorbidities can show whether antibody benefit and ARIA risk still justify treatment outside the original label population.","rationale":"Current phase 3 cohorts are cleaner than clinic. Access decisions still hit mixed disease.","test":"Registry-based randomised or well-controlled observational comparison with ARIA and function as co-primary, stratified by vascular burden and anticoagulation.","maturity":"speculative","actor":"research","cost":"large","horizonYears":8},{"id":"da-idea-blood-first-triage","kind":"idea","name":"Blood test before PET or lumbar puncture","aka":[],"tldr":"Use a blood test to decide who still needs a scan or spinal-fluid test, instead of sending everyone to PET.","summary":"This is a proposed clinic pathway, not a licensed consumer diagnosis. The test has to beat sending everyone, and it has to fail safe.","asOf":"2026-09-21","links":[{"label":"NIA","url":"https://www.nia.nih.gov/health/alzheimers-and-dementia"}],"tags":["dementia-atlas"],"related":[],"cancers":["alzheimers-disease","mild-cognitive-impairment"],"sections":[],"technologies":["da-tech-blood-biomarkers"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-late-diagnosis"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A validated plasma assay can reserve amyloid PET and CSF for people whose blood result is intermediate or whose clinical picture still needs confirmation.","rationale":"PET and lumbar puncture are accurate but scarce. A blood-first path could shorten waits if false reassurance is controlled.","test":"Prospective memory-clinic study: plasma assay then PET or CSF reference, with pre-specified sensitivity for a negative blood test and a decision-impact endpoint (fewer unnecessary scans without missed antibody candidates).","maturity":"early-clinical","actor":"clinic","cost":"medium","horizonYears":5},{"id":"da-idea-carer-outcome-primary","kind":"idea","name":"Make carer outcomes a primary trial endpoint","aka":[],"tldr":"Judge dementia treatments by whether households cope better, not only by a clinic memory score.","summary":"Would require regulators and funders to accept carer measures as more than exploratory.","asOf":"2026-09-21","links":[{"label":"CDC caregiving","url":"https://www.cdc.gov/caregiving/index.html"}],"tags":["dementia-atlas"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["da-bn-caregiver-load"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Trials that treat carer time, sleep, and distress as primary endpoints will select treatments that work in households, not only on a cognitive scale.","rationale":"Unpaid care is the delivery system. A medicine that slightly moves a scale but increases infusion burden can still fail families.","test":"Add a pre-specified carer time-and-distress primary or co-primary to a phase 3 or post-licence study, with a published analysis plan.","maturity":"speculative","actor":"policy","cost":"medium","horizonYears":6}]